Tillie Doyle
Panoramic dental x-rays are a commonly used diagnostic tool in dentistry and oral surgery. They are extraoral, meaning the imaging machine is outside of the patient's mouth. This makes them more comfortable for the patient, as they do not need to open their mouth wide or have instruments placed inside. Panoramic x-rays produce a two-dimensional image of the entire mouth, including the teeth, jaws, and surrounding anatomy. They are useful for diagnosing dental problems and planning treatments such as braces, implants, or dentures. While they are generally safe, with a low dose of radiation, it is important for patients to remove any metal objects and inform the dentist if they are pregnant.
| Characteristics | Values |
|---|---|
| Radiation exposure | A panoramic dental X-ray exposes patients to about 0.01 millisieverts of radiation, a small dose. |
| Preparation | No special preparation is required. Patients may be asked to remove metal objects from the neck up, including jewelry, eyeglasses, and piercings, as these can interfere with the X-ray images. |
| Procedure | The patient stands or sits in the center of the unit, with their head carefully positioned and secured. The X-ray tube rotates in a semicircle around the patient's head, starting at one side of the jaw and ending at the other. |
| Image | A panoramic dental X-ray produces a 2-dimensional image of the entire mouth, including the upper and lower jaws, teeth, TMJ joints, nasal area, sinuses, and surrounding structures. |
| Benefits | Panoramic X-rays provide a comprehensive view of the entire mouth, aiding in the diagnosis and treatment of oral health issues. They are also useful for planning treatments such as braces, implants, or dentures. |
| Drawbacks | Panoramic X-rays can be affected by factors such as patient positioning, tongue placement, and the presence of a lead apron, resulting in artifacts or errors in the image. |
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What You'll Learn
Preparation: Remove metal objects and wear a lead apron
Preparing for a panoramic x-ray is a straightforward process. It requires little to no special preparation. However, there are a few important steps to follow to ensure the procedure runs smoothly and safely. Firstly, it is essential to remove any metal objects, such as jewellery, eyeglasses, or other metal items that could interfere with the x-ray images. This is a standard precaution to ensure the clarity of the x-ray images.
Secondly, you will be provided with a lead apron to wear. This apron is designed to protect your body from radiation exposure. The lead apron is a safety measure to shield your body from any scattered radiation from the panoramic x-ray beam. It is important to note that the use of lead aprons during dental x-rays is currently the subject of changing guidelines. While it has been standard practice for many years, some professional organisations, such as the American Dental Association, no longer recommend their routine use. This change is due to advancements in x-ray technology, which have significantly reduced radiation exposure, and the understanding that lead aprons can sometimes interfere with imaging and even increase radiation exposure in certain cases.
Despite these new recommendations, it is important to note that some states still require the use of lead aprons by law. Additionally, patients may feel more comfortable continuing to wear them, and providers may offer them upon request. It is worth noting that the radiation exposure from a panoramic x-ray is minimal and that the lead aprons are not necessary for facial x-rays.
To ensure the effectiveness of the lead apron, it is important to inspect it for any damage before use. This includes checking the seams, belts, fastening devices, and the surface of the apron for any lumps, cracks, sagging, or separation from the seams. If any issues are identified, the apron should be inspected radiographically to determine if it needs to be rejected. Proper storage and handling of the apron are also crucial, as lead aprons should be stored on hangers and avoided folding or creasing to prevent damage to the lead lining.
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Positioning: Stand tall, with your head centred and secure
To prepare for a panoramic x-ray, you will first be asked to remove any metal objects, such as jewellery, dentures, earrings, necklaces, hair clips, eyeglasses, and facial piercings, from the region being imaged. Metal objects can interfere with the x-ray images. You will then be given a lead apron to wear as a safety precaution to protect your body from radiation exposure.
Next, you will be positioned in the panoramic machine. It is important to stand tall, with your head centred and secure. The unit can be adjusted to accommodate a patient standing or sitting in a wheelchair. The technician will carefully position and secure your head, and then place a bite-blocker in your mouth to ensure your teeth are correctly aligned. You may be asked to bite on a plastic stick with your front teeth in grooves on the stick while your chin rests on a platform. It is important that you are centred on the stick, and the operator will make any necessary adjustments.
You will be guided to rest your chin and head on the designated resting spots. There are handles to hold on to to help you stay still during the x-ray. The machine will move around your head while you stay still in place. The x-ray tube rotates in a semicircle around the patient's head, starting at one side of the jaw and ending at the other.
To ensure a clear image, it is important to hold your tongue flat against the top of the hard palate. Additionally, the ideal spine position is erect, or even better, stretched, rather than hunched or "goosenecked". To achieve this, you can hold the grab bars on the unit and move your feet forward so that you are in a "leaning back" position.
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Tongue placement: Press tongue flat against the palate
Pressing the tongue flat against the palate is a crucial step in the process of taking panoramic X-rays, also known as "panos". This type of X-ray is a two-dimensional (2D) dental X-ray examination that captures the entire mouth, including the teeth, upper and lower jaws, surrounding structures, and tissues, in a single image. It is commonly used by dentists and oral surgeons to plan treatments such as braces, implants, or dentures.
The tongue placement during a panoramic X-ray is important for obtaining a clear image. The patient's tongue should rest on the hard palate, with the lips closed around the bite block. This helps to prevent tissue projection errors, specifically the "tongue drop" error. If the tongue is not placed correctly, it can cause a radiolucent band to be superimposed over the apices of the maxillary teeth, creating the appearance of a radiolucent, cyst-like radiolucency in the maxillary midline.
To ensure proper tongue placement, the clinician should provide clear instructions to the patient before the X-ray. The patient should be instructed to place the tongue on the roof of the mouth and keep it there throughout the entire exposure. The clinician should also remind the patient to remain stationary until the exposure is complete.
In addition to tongue placement, there are other important factors to consider for optimal panoramic X-ray results. These include correct head positioning, removing any metal objects that could interfere with the X-ray images, and wearing a lead apron to protect against radiation exposure. Overall, the appropriate technique is key to achieving accurate and useful panoramic radiographs.
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Spine position: Avoid a hunched spine for clearer images
A hunched spine can be caused by a condition called kyphosis, which is an excessive forward curve of the spine. This can cause back pain and stiff muscles, as well as making it difficult to stand straight. In severe cases, kyphosis can even cause breathing issues.
To avoid a hunched spine during a panoramic x-ray, the patient should be positioned carefully, with their head centred in the unit and their chin and head resting on designated spots. The patient will then be asked to bite down on a guide to ensure their teeth are correctly aligned.
For x-rays of the spine, the patient will be positioned on an x-ray table that carefully places the part of the spine to be x-rayed between the x-ray machine and a cassette containing the x-ray film or digital media. The patient may be asked to stand or sit for the x-ray, depending on the area being imaged. It is important to remain as still as possible during the exposure to avoid distorting the image.
To obtain clearer images of the spine, full-body EOS spine imaging can be used to capture weight-bearing postures and interactions between the hips, spine, knees, and neck. This type of imaging provides precise, reviewed 3D images that can be used for surgical planning.
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Machine operation: Requires a skilled operator to capture the image
While a panoramic dental X-ray is an easy and painless process for the patient, it requires a skilled operator to capture the image. The machine moves around the patient's head, taking continuous snapshots to form a 2D or 3D image of the patient's anatomy. The X-ray technician directs the machine to project a beam through the patient's mouth onto a film that rotates opposite the X-ray tube. The X-ray lasts between 12 and 20 seconds.
To ensure a clear image, the patient's head must be carefully positioned and secured. The patient will be asked to stand or sit in the centre of the unit, with their chin and head resting on designated spots, and they will be asked to bite down on a guide or stick. The patient's head position should be adjusted so that they are centred on the stick. The patient should also be instructed to hold their tongue flat against the top of the palate to avoid a common cloudy fuzz artifact down the centre of the image.
The patient should be asked to remove any metal objects such as jewellery, dentures, earrings, necklaces, hair clips, eyeglasses, and facial piercings, as these objects will block the path of the X-ray beam. The patient will be given a lead apron to wear to protect the body from radiation exposure. However, care should be taken to ensure the lead apron is not draped too high on the back of the patient, as this can also cause an artifact in the image.
The patient's posture is also important for a clear image. If the patient is hunched, the X-ray must travel through more bone, which can result in cloudiness in the image. The patient should be asked to hold the grab bars and lean back, with their feet placed forward, to straighten their spine.
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Frequently asked questions
A panoramic x-ray, or pano, is an x-ray imaging technique that captures a 2-dimensional picture of the entire mouth, including the teeth, jaws, and surrounding anatomy.
No special preparation is required for a panoramic x-ray. However, you may be asked to remove any metal objects such as jewelry, eyeglasses, or facial piercings, as these can interfere with the x-ray images. You will also be given a lead apron to wear as a safety precaution.
During the procedure, you will be positioned in the center of the x-ray machine, with your chin and head resting on designated spots. You may be asked to bite down on a plastic stick or bite blocker to align your teeth. The x-ray tube will then rotate in a semicircle around your head, capturing images of your mouth and jaws.
Panoramic x-rays provide a comprehensive view of the entire mouth, allowing dentists to quickly identify any oral health issues. They are also useful for planning treatments such as braces, implants, or dentures.
Panoramic x-rays use a small dose of ionizing radiation to capture images of the mouth. While the radiation exposure is considered low, it is important to inform your dentist if you are pregnant as there may be risks associated with fetal exposure.
